Care Manager, Registered Nurse
$171,558–$240,157 year
On-siteDavis, California, United States
EXPIREDDavis, California, United StatesOn-sitePart Time$171,558–$240,157 yearLicense Or CertificationEnterprise
Part TimeLicense Or CertificationEnterprise
Job Summary
Coordinate care transitions and plan transitions for acute care patients by collaborating with physicians, social workers, and bedside nurses to ensure timely progression to appropriate care levels. Facilitate communication across the care continuum by managing resources, addressing complex clinical and social situations, and preventing unnecessary admissions or readmissions. Engage with patients, families, interdisciplinary teams, and third-party payers to promote optimal health, access to care, and appropriate resource utilization while maintaining regulatory compliance.
Required Qualifications
- Graduate of an accredited school of nursing
- RN-Registered Nurse of California Upon Hire
- 2 years of experience in acute care case management or health plan case management/utilization management
- A broad knowledge base of health care delivery and case management within a managed care environment
- Comprehensive knowledge of Utilization Review, levels of care, and observation status
- Working knowledge of laws, regulations, and professional standards affecting case management practice in an integrated delivery system: including but not limited to: CMS, Title 22, CHA Consent Manual, CDPH and TJC
- A broad knowledge base of post-acute levels of care and associated regulatory compliance requirements
- Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners
- Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families
- Demonstrates commitment to service excellence in all patients, family and employee interactions and in performing all job responsibilities
- Strong verbal and written communication skills and negotiation skills
- Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities
- Intermediate computer and technology skills
- Ability to promote teamwork and to effectively function in teams
- Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience
- Must be able to handle hazardous drugs in the course of their work, including patient care, which requires them to manage, store, prepare, receive, unpack, transport, dispose of, or administer drugs identified as hazardous or potentially hazardous by the National Institute for Occupational Safety and Health (NIOSH) and in accordance with the USP 800 guidelines
- Must be available for Rotating Weekends
Desired Qualifications
- Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems preferred
- General understanding of coding and DRG assignment process preferred
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